Tuberculosis disease is treatable and curable. Drug-susceptible strains of tuberculosis can be treated with relatively inexpensive medications.
- Medications: To prevent the development of drug resistance, all treatment regimens for tuberculosis disease incorporate multiple medications throughout the course of therapy.The medications most commonly used to treat tuberculosis disease include isoniazid (INH), rifampicin, pyrazinamide (PZA), and ethambutol. All four medications are available orally. For children with central nervous system tuberculosis or with drug-resistant strains of tuberculosis, other medications may be required.
- Tolerability: Children usually tolerate tuberculosis medications better than adults.
- Adherence: Medications, whenever possible, should be administered by representatives of tuberculosis control programs or their designees. This is termed directly observed therapy (DOT), and has been shown to enhance medication adherence. Adherence can be diminished by the long duration of therapy (6-12 months) needed to cure tuberculosis disease. Consequently, use of fixed-dose combination pills (to decrease pill burden), supervised therapy, and frequently visits to medical professionals to monitor progress and evaluate for side effects are essential.
Tuberculosis disease is preventable. Prevention strategies are multifaceted and include the BCG vaccine, identification of persons with active TB disease to prevent community spread, provision of chemoprophylaxis, and infection control in healthcare settings.
- Vaccine: The bacille Calmette-Guérin (BCG) vaccine is widely administered in many countries. This vaccine prevents disseminated and life-threatening forms of tuberculosis disease in infants. However, the BCG vaccine does not prevent disease in older children and adults. Many groups are working on a better tuberculosis vaccine, but none currently are available.
- Identification of Persons with Active TB Disease: The United Nations has identified halving tuberculosis disease prevalence and death rates by 2015 in their Millenium Development Goals. In part, this will be accomplished by the identification and treatment of the most contagious individuals (persons with pulmonary tuberculosis disease). This will decrease community spread and identify at-risk individuals in contact with these persons who would most benefit from prophylactic therapy.
- Provision of Chemoprophylaxis: Persons with latent tuberculosis infection serve as reservoirs of future disease cases. It is estimated that 5-10% of all persons with TB infection will develop tuberculosis disease in their lifetime; this rate is substantially higher in very young children and in immunocompromised individuals). However, this rate of progression to tuberculosis can be reduced with administration of a single medication, usually isoniazid.
- Infection Control in Healthcare Settings: Transmission of tuberculosis within healthcare settings can be decreased by screening patients for tuberculosis symptoms, respiratory isolation, prompt initiation of effective therapy, and use of personal protective equipment. While many infection control measures used in industrialized settings may not be readily implemented in resource-poor settings, the World Health Organization has specific guidelines on infection control that may be applicable to a variety of settings.
Venues for Care
Children with tuberculosis disease receive care at all the Baylor International Pediatric AIDS Initiative Centers of Excellence in sub-Saharan Africa and Romania. Children in Houston, Texas, receive care at the Children’s Tuberculosis Clinic at Texas Children’s Hospital.
The Children’s Tuberculosis Clinic at Texas Children’s Hospital
Para informes sobre tuberculosis en español, favor de oprimir aqui: Informes Sobre la Clinica de Tuberculosis.
The Children’s Tuberculosis Clinic was established over 25 years ago and is the largest pediatric tuberculosis clinic in the United States. It is staffed by Drs. Jeffrey Starke and Andrea Cruz, Anna Mandalakas and Lydia Ong, PA-C.
Services provided: children with tuberculosis exposure, infection, and disease are cared for at this clinic.
- Placement and interpretation of tuberculin skin tests (PPDs)
- Obtaining and interpreting interferon gamma release assays (IGRAs)
- Chest radiographs (x-rays) and other radiographic studies, as needed
- Laboratory services
- Coordination with other consulting services
- Admission to Texas Children’s Hospital, if necessary
Location and times: The clinic is located on the 16th floor of the Clinical Care Center of Texas Children’s Hospital (6701 Fannin Street, Houston, Texas 77030; this is on the corner of Fannin Street and Holcombe Boulevard). The clinic meets Tuesday and Friday mornings. The first appointment is at 8:00 AM, and the last appointment is at 10:00 AM.
Download Location Map as PDF
Parking: Parking is available at several Texas Medical Center parking garages.
Referrals: Referrals to TB Clinic occur several ways. We accept referrals from community physicians, health departments, and children hospitalized with suspected tuberculosis.
- Referrals from community physicians: Physicians can call Texas Children’s Hospital Central Scheduling at (832) 822-2778. They will be connected with the Infectious Disease office and be asked to complete a form (Download Form) providing additional clinical information. Children need not have chest radiographs prior to arrival in TB clinic; we can obtain these at the time of the initial visit. However, if a child has already had a chest radiograph, it is helpful if the copies of this film can be given to the family to bring to their appointment.
- Referrals for children hospitalized with suspected tuberculosis disease: Physicians can call Texas Children’s Hospital Central Scheduling at (832) 822-2778. They will be connected with the Infectious Disease office and be asked to complete a form (Download Form) providing additional clinical information, diagnostic test results, and medication dosing. We prefer that children have an appointment scheduled prior to hospital discharge, to prevent barriers to care. Please send the following forms to the health department corresponding to the child prior to the child’s discharge:
- Reporting forms:
- Directly observed therapy (DOT) orders: